Mural nodule in branch duct–type intraductal papillary mucinous neoplasms of the pancreas is a marker of malignant transformation and indication for surgery

Akita, Hirofumi; Takeda, Yutaka; Hoshino, Hiromitsu; Wada, Hiroshi; Kobayashi, Shogo; Marubashi, Shigeru; Eguchi, Hidetoshi; Tanemura, Masahiro; Mori, Masaki; Doki, Yuichiro; Nagano, Hiroaki

doi:10.1016/j.amjsurg.2010.06.020

Cited by 51 publications

(47 citation statements)

References 21 publications

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“…1). Of these studies, 33 investigated mural nodules5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 21 examined dilatation of the main pancreatic duct (MPD)7 9, 15 16, 18 21, 23 26, 27 30, 32 36, 38, 39, 40, 41, 42, 43, 44, 45, 46, 21 analysed cyst size5 7, 8, 9 14, 15 18, 20 23, 25 27, 28 31, 36 38, 40 41, 43 47, 48, 49, 17 assessed CA19‐9 increase…”

Section: Resultsmentioning

confidence: 99%

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

et al. 2018

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BackgroundEstimation of the risk of malignancy in intraductal papillary mucinous neoplasia (IPMN) of the pancreas is a clinical challenge. Several routinely used clinical factors form the basis of the current consensus guidelines. This study aimed to determine the predictive values of the most commonly assessed risk factors.MethodsA meta‐analysis of individual risk factors of malignancy in IPMN was performed. Contingency tables were derived from these data, and sensitivity, specificity, negative and positive predictive values, and diagnostic odds ratios (DOR) were determined. Hierarchical summary receiver operating characteristic (HSROC) curves for each factor were calculated and the respective area under the curve (AUC) was assessed.ResultsA total of 3443 studies were screened initially. Analysis of recent literature revealed 60 studies with 13 relevant risk factors including clinical, serological and radiological parameters. The largest area under the HSROC curve was found for weight loss (0·84) and jaundice/raised bilirubin level (0·80), followed by increased carcinoembryonic antigen (CEA) (0·79) or carbohydrate antigen (CA) 19‐9 (0·78) levels. The most sensitive factors were patient age (71 per cent) and mural nodules (65 per cent), and jaundice/raised bilirubin level (97 per cent) and increased CEA level (95 per cent) were most specific. None of the analysed factors reached a positive or negative level of prediction beyond 90 per cent.ConclusionNone of the established criteria safely distinguishes malignant from non‐malignant lesions.

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Section: Resultsmentioning

confidence: 99%

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

et al. 2018

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“…17 Several recent studies reported that the size of mural nodules was a more significant malignant factor than the tumor size for predicting the malignancy of branch duct type IPMN. 6,10,12,14 In addition, the MPD size, positive EUS fine-needle aspiration (FNA) cytology, and high CEA or carbohydrate antigen (CA)72.4 levels in the cystic fluid have been reported to be factors that can be used to predict the malignancy of branch duct type IPMN. 5,[18][19][20][21] However, the accuracies of these factors were not high enough to distinguish between benign and malignant IPMNs.…”

Section: Discussionmentioning

confidence: 99%

“…4-6,10 However, there is still no definite management consensus, including the surgical indications, for patients with branch duct type IPMN, because the malignant potential of branch duct type IPMN is relatively low. [10][11][12][13][14] Thus, it is necessary to identify more accurate factors that can predict the malignancy and determine the indications for surgical resection for the patients with the branch duct type IPMN.…”

Section: Discussionmentioning

confidence: 99%

“…Many recent clinicopathological studies have shown that IPMNs arising in the main pancreatic duct (MPD) are more aggressive than those arising in the branch pancreatic duct (BPD), and the malignancy rate of main duct type IPMN has been reported to be 57% to 92%, [4][5][6]10 whereas that of branch duct type IPMN has been reported to be 6% to 58%. [10][11][12][13][14] Therefore, although most clinicians agree that surgical resection is required for all main duct type IPMNs, the management of branch duct type IPMNs remains controversial, because branch duct type IPMN generally has a low risk of malignancy.…”

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The Carcinoembryonic Antigen Level in Pancreatic Juice and Mural Nodule Size Are Predictors of Malignancy for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

Hirono

Tani²,

Kawai³

et al. 2012

Annals of Surgery

130

107

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“…5 Postoperative CT angiography revealed that the abdominal aorta was replaced about 4 cm below the renal arteries [29] reported that 19 (86.3%) of 22 cases of resected IPMN with mural nodules were malignant, whereas 14 (77.8%) of 18 resected IPMN without mural nodules were benign. Akita et al [30] also reported that the presence of mural nodules in branch duct-type IPMN is a potentially suitable marker for differentiating carcinoma from adenoma, and is important for making decisions about surgical interventions. The branch duct-type IPMN of this case had mural nodules, and surgery was considered to be appropriate based on the possibility of malignancy.…”

Section: Discussionmentioning

confidence: 95%

A one-stage operation for abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas: report of a case

Tsuji¹,

Kitano²,

Sawada³

2012

Surg Today

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Pancreatic surgery concomitant with abdominal aortic repair is rarely chosen due to concerns about prosthetic infection following pancreatic leakage and the poor prognosis of pancreatic neoplasms. We herein report a successfully treated case of infrarenal abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas treated by a one-stage operation. A 75-year-old male with a history of cerebral infarction and chronic subdural hematoma was referred to our department with a pulsatile abdominal mass. A 70-mm infrarenal abdominal aortic aneurysm with severe proximal neck angulation and a 28-mm multilocular cystic tumor with mural nodules in the pancreas body were detected. Abdominal aortic repair with a prosthetic graft and distal pancreatectomy were performed simultaneously. The postoperative course was mostly uneventful, and he was discharged to a rehabilitation facility.

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Mural nodule in branch duct–type intraductal papillary mucinous neoplasms of the pancreas is a marker of malignant transformation and indication for surgery

Cited by 51 publications

References 21 publications

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

The Carcinoembryonic Antigen Level in Pancreatic Juice and Mural Nodule Size Are Predictors of Malignancy for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

A one-stage operation for abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas: report of a case

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